Individual
ANGELA MARIE MATTERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
60101 BODNAR BLVD STE 100B, MISHAWAKA, IN 46544-9340
(574) 335-8800
(574) 335-0613
Mailing address
5215 HOLY CROSS PKWY, PROVIDER SERVICES-ENROLLMENT, MISHAWAKA, IN 46545-1469
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71007221A
IN
363LF0000X
Family Nurse Practitioner
Primary
71007221A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300004473
—
IN
Enumeration date
06/01/2017
Last updated
01/16/2025
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